Structured data authoring and editing system

ABSTRACT

The present invention offers an extensive suite of tools that facilitate and enhance the capability within a healthcare institution to establish and maintain an evidence-based best practice approach to providing patient care. Using evidence, term vocabulary and default structured content (order sets) embodiments of the invention enable the localization of said content in a well structured environment.

RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional PatentApplication Ser. No. 60/718,169, filed on Sep. 16, 2005, entitled“Structured Data Authoring and Editing System,” incorporated herein byreference.

BACKGROUND

Proprietary tools exist to allow healthcare order set content to becustomized within the context of a vendor's particular data authoringand customizing system. However, such single-vendor systems may beoverly constraining where an organization needs to customize content foruse with systems and applications from multiple vendors. One exemplaryapproach to address this issue might be for industry participants toestablish an industry-standard format or toolset for order set contentauthoring and customization. However, to date, an industry standard hasnot arisen and toolsets for review, customization and integration ofevidence based content structures are generally sponsored by a singlehealthcare application vendor and designed to best fit with thatvendor's environment. Advantages may be obtained by a toolset thatallows for the improved sharing of data between multiple vendor healthcare data management systems.

SUMMARY OF THE INVENTION

The invention relates to a system and methods for the review,customization and integration of health care-related content structures,also referred to as clinical content. In various embodiments, a platformfor the review, customization and integration of such content structuresand, in one exemplary embodiment, for the review, customization andintegration of order sets, used in healthcare applications is disclosed.One such example implementation of such an embodiment is referred to asthe “Zynx” platform and the authoring environment of that platform isreferred to as “AuthorSpace.” It should be understood that the Zynxplatform is presented as an exemplary non-limiting implementation, andthat features of the platform and authoring environment may or may notbe included in a particular implementation or embodiment.

Some embodiments may help users take steps to reduce undesirablevariations in patient care and help such users make decisions intendedto facilitate improvements in quality, safety, and efficiency of patientcare. In general, some embodiments may help inform clinicians at the“point of care” about evidence-based or scientific approaches todiagnosing and treating patients that could, in turn, help those usersto achieve the best possible patient outcomes. In some embodiments, thisinformation is provided in a manner that can be integrated with existinghealth care information technology, including computerized physicianorder entry and electronic health records, including, for example,billing information, or other patient or clinical information.

In one embodiment, a service provider, also referred to as aninformation provider, may create electronic content, such as order sets.An example of such a service provider is Zynx Health Incorporated, ofLos Angeles, Calif. Order sets may represent a collection of orders andnotations that are relevant to treating a given condition under a givenset of circumstances based upon current evidence. The order sets createdby a service provider may be a superset of order items available at ahealthcare institution (and, in a typical implementation, will containall relevant order items). Since most healthcare institutions do nothave an all-encompassing selection of treatments and services, the orderset content must be tailored by an institution to the items that suchinstitution is prepared to provide. This process of tailoring may bereferred to as customizing the order set.

In some embodiments, an environment may be provided that allows theproviders of care, for example a single practitioner or practitionergroup, clinic, hospital, urgent care facility, nursing home, healthnetwork, or some combination, to customize and share clinical content.It may even be shared across multiple potential healthcare systems. Todo this, some embodiments provide a tool that allows for the creation ofcontent using a common nomenclature and structure, to facilitate thecustomization of the content to fit the needs of the healthcareinstitutions via a intuitive user interface and, upon completion of thecustomization process, transforms the content dynamically into a formatthat could be consumed by the healthcare application(s) used by theinstitution.

Some implementations may also provide added value to the authors/editorscustomizing the content by allowing them to use an authoring environmentfor editing clinical content provided by others in addition to initialcreation of content. To do this, some embodiments provide tools tomaintain integrated content beyond the order set, to maintain theintegrity of the content, and to preserve each version of the contentover time for the purposes of historical reference.

Some implementations may also take into consideration certain localpreferences and have the ability to be aware of local workflow. Someimplementations may also provide content management environments thatsupport the consumption of the content by other systems. This, forexample, allows health networks to exchange relevant data with multipleapplications across an institution as well as at separate institutionswith different healthcare applications.

Some embodiments may be designed to solve a number of problems withexisting order set management applications, and bridge the integratedcontent gap between healthcare applications. In some embodiments, aweb-based software application is designed to allow customers of aninformation provider (e.g., an evidence-based information provider) tocreate and customize evidence-based structured content for the purposeof users' integration into the healthcare system of their choice. Otherembodiments, e.g., in stand-alone applications, may also be used.

Structured content such as that created in an authoring environment maybe based on a predefined vocabulary of terms, referred to as a PIVOTcatalog (Portable Intermediate Vocabulary of Objective Terms). Thecreated content may be any sort of health care or related content,including without limitation order sets, plans of care, rules (e.g.,rules for alerting), alerts, protocols, performance measures, and/orstructured documentation. The created content may include combinationsof these, and may also include other information, such as links torelevant evidence documentation or practice patterns. In someembodiments, when an end-user wants to use the structured contentcreated in an authoring environment in their healthcare application,they can use an export functionality to convert the content intopre-coordinated terms that will work in their target application. Theexport format itself may be customized to each target system for ease ofimport. The combination of the standard content format and the customexports and vocabulary transformation allows content authored in such anauthoring environment to be portable. Content authored by one user, ifshared, could be used by another user regardless of their healthcaresystem vendor or local terminology.

In some embodiments, an authoring environment is provided that is avirtual place where like users can work together on authoring content.Administrators can create teams within an environment as well as definelocal milestones and review content created/edited by others. A typicalscenario is a single environment supporting the users for a giveninstitution, such as a hospital or nursing home. In some cases, anenvironment can represent one practitioner group office, or an entirehealth network that includes several hospitals. Typical implementationsof such an environment may support user-based security features. Forexample, in a typical implementation, access to the authoringenvironment requires a username and password. Users are given certainprivileges with respect to content in their environment by theenvironment administrator, which is typically a power-user from thehospital or health network. In addition, audit features may beimplemented so that changes made to content in an authoring environmentcan be tracked and audited.

In general, in one aspect of the invention, a method for review andadoption of an evidenced-based content structure includes selecting anevidenced-based content structure. The content structure may beprovided, for example, by an information provider, a user, a relatedinstitution, or by another person or entity. The content structure maybe any sort of content structure, but in one preferred embodiment is anevidence-based order set. The method also includes duplicating thestructure in an authoring environment and reviewing the duplicatedstructure. The method also includes customizing the structure based onthe review, releasing the customized structure and integrating thestructure into an application environment. In some embodiments, theevidenced-based content structure may include an order set.

In various embodiments, one, two, or three of these steps may beincluded or omitted, for example, the step of duplicating the structuremay be optional, the step of integrating the structure into anapplication environment may be optional, and/or the step of customizingthe structure in response to the review may be optional.

In some embodiments, the content structure may be integrated intomultiple application environments, which may be, for example, the sameor different types of application environments. Moreover, in variousembodiments, the application environment may be a healthcareenvironment, a healthcare information technology (HIT) applicationenvironment, a live HIT application environment or another suitableenvironment. In various embodiments, the method may be implemented by aweb-based system, for example, such that users may use a web browser toaccess the system. The system can check username and password, andassign privileges to each user. The duplicated structure may be reviewedin a variety of ways, for example by an internal review, a publicreview, or by comparing the structure against local practice and/or acatalog. The method also may include exporting the structure in a vendorformat or vocabulary, or translating the structure.

In general, in another aspect of the invention, a system for review andadoption of an evidenced-based content structure comprises a contentlibrary for selection of a content structure. The system also includes acontent manager for duplication and eventual release of the contentstructure and a content review tool for review of the structure. Thesystem also includes a content editor for customization of thestructure, and an environment manager for integration of the structureinto an application environment.

In general, in another aspect of the invention, an article ofmanufacture having computer-readable program portions for review andadoption of an evidenced-based content structure comprisescomputer-readable instructions for selecting an evidenced-based contentstructure, duplicating the structure, reviewing the duplicatedstructure, customizing the structure in response to the review,releasing the customized structure, and integrating the structure intoan application environment. As described above, in some embodiments, thestructure is integrated across multiple environments, and in otherembodiments the computer-readable instructions may implement a web-basedsystem.

In general, in another aspect, a method for updating a revisedevidenced-based content structure includes drafting a first structureprovided by a user, reviewing the first structure, releasing the firststructure, drafting a second structure, reviewing the second structure,releasing the second structure, and retiring the first releasedstructure. The evidenced-based content structure preferably may be anorder set. In some embodiments, the method is performed by a web-basedsystem. The reviewing step may be performed, for example, by an internalreview, a public review, by comparing the structure against localpractice and catalog, or some combination. In some embodiments, draftinga structure may include editing the structure. In other embodiments,reviewing a structure disables editing capabilities. Moreover, releasinga structure may include stamping the structure with a version number ormay permanently lock the structure. The method may further includepermanently storing retired structures.

In general, in another aspect, a system for updating a revisedevidenced-based content structure comprises a content manager fordrafting of a first structure provided by a user, review of the firststructure, release of the first structure, drafting of a secondstructure, review of the second structure, release of the secondstructure, and retirement of the first released structure. The systemcan also include permanent storage of retired structures.

In general, in another aspect, the invention relates to an article ofmanufacture having computer-readable program portions for updating arevised evidenced-based content structure comprises computer-readableinstructions for drafting a first evidenced-based content structureprovided by a user, review of the first structure, release of the firststructure, drafting of a second structure, review of the secondstructure, release of the second structure, and the retirement of thefirst released structure.

In general, in another aspect, the invention relates to a system forreview and export of an evidenced-based content structure. The systemincludes an authoring environment for reviewing and/or editing thestructure. The system also includes a vocabulary transformation enginefor transforming the structure into a standard structure as well as acustom export engine for converting the standard structure into anexport structure in a particular vendor system format. In variousembodiments the evidenced-based content structure may be an order set.In some embodiments the system is web-based. The authoring environmentmay include a content library, a content editor, a content manager, acontent review tool, a global content editor, a notification manager andan environment manager. The system may include multiple custom exportengines, each for converting the standard structure into respectiveexport structures in different vendor system formats.

In general, in another aspect, a method for automated conversion of anevidenced-based content structure includes selecting a structureprovided by a user, transforming the structure into a standardstructure, and converting, through an automated process, the standardstructure into an export structure in a particular vendor system format.In some embodiments the method may be implemented by a web-based system.The evidenced-based content structure may be an order set. In otherembodiments, the standard term vocabulary may be mapped to multipletarget vocabularies. The target vocabulary may be a national standardcode (e.g. SNOMED, LOINC, NDC's, CPT4, ICD9-CM, and so on), a vendorvocabulary, or a local catalog vocabulary.

In general, in another aspect, a system for mapping an evidenced-basedcontent structure to a target vocabulary uses a vocabulary map whichtransforms the structure into a standard term vocabulary and maps thestandard term vocabulary to a target vocabulary.

In general, in another aspect, a system for collaborative review of anevidenced-based content structure includes first and second authoringenvironments for reviewing and/or editing the structure. In the system,users in each authoring environment are granted access only to theirauthoring environment (i.e., a user in the first authoring environmentis only granted access to the first authoring environment, and a user inthe second authoring environment is only granted access to the secondauthoring environment). In some embodiments, the authoring environmentsare each associated with hospitals. In some embodiments, if theauthoring environments are related through a common network (i.e., acommon health network) a user in the first authoring environment may begranted some degree of access to the second authoring environment and inother embodiments, a user in the second authoring environment may begranted limited access to the first authoring environment. In someembodiments, a user's access to an authoring environment is controlledby a password, or their access is granted based on their role on a team.A user's access may be view-only or may include content rights.

In general, in another aspect, a method for collaborative review of anevidenced-based content structure (i.e., an order set) which includesproviding a first and second authoring environment for reviewing and/orediting the structure, and granting access to a user in the firstauthoring environment to the first authoring environment only andgranting access to a user in the second authoring environment to thesecond authoring environment only. If the authoring environments (whichcan be associated with hospitals, or other medical offices, practicesinstitutions, or facilities and so on) are related through a commonnetwork such as a common health network, a user in the first authoringenvironment may be granted limited access to the second authoringenvironment. A user's access to an authoring environment may be, forexample, view-only, or may include content editing permissions.

In general, in another aspect, a method for managing a life cycle of anevidenced-based content structure includes adding and updating specificlifecycle events to the structure, posting a review of the structure,viewing the review of the structure, displaying a change in thestructure, marking the structure as a protocol, and publishing thestructure for use within an environment's view space. In variousembodiments the environment is a healthcare environment. The changesmade to the structure may be logged in an audit trail database and whenmarking the structure as a protocol, the structure may be virtuallylinked into another structure. Moreover, when publishing the structureinto an environment's viewspace, non-authoring environment users may seethe structure in a non-authoring environment website.

In general, in another aspect, a system for managing a life cycle of anevidenced-based content structure (i.e., an order set) includes acontent manager with a module for adding and updating environmentspecific lifecycle events to the evidenced-based content structure. Thesystem also includes a module for posting a review of the structure anda module for viewing the review of the structure. The system also mayinclude a module for displaying a change in the structure, a module formarking the structure as a protocol, and a module for publishing thestructure into a view space.

The details of one or more embodiments of the invention are set forth inthe accompanying drawings and the description below. Other features,objects, and advantages of the invention will be apparent from thedescription and drawings, and from the claims.

DESCRIPTION OF THE DRAWINGS

FIG. 1 is a schematic illustration of the process flow of the system ofthe present invention.

FIG. 2 is a schematic illustration of the end user workflow supported bythe system of the present invention.

FIG. 3 is a schematic illustration of the nature and process flowrelated to the update process supported by the system of the currentinvention.

FIG. 4 is a schematic illustration of the mapping process thatfacilitates essential transformation of terminology in the system of thepresent invention.

FIG. 5 is a schematic representation of how healthcare institutions areallocated authoring environments in the system of the present invention.

FIG. 6 is a schematic representation of how users are allocated toauthoring teams within environments and assigned privileges to performcertain functions in the system of the present invention.

FIG. 7 is an illustrative example of the user interface in a preferredembodiment of the present invention displaying the main information,search and navigation page.

FIG. 8 is a schematic representation of the functions accessible fromthe main information, search and navigation page of the system of thepresent invention.

FIG. 9 is an illustrative example of the user interface in a preferredembodiment of the present invention displaying the order set editor.

FIG. 10 is an illustrative example of the user interface in a preferredembodiment of the present invention displaying the order set manager.

FIG. 11 is a schematic illustration of how the status of content in anauthoring environment changes throughout its lifecycle in the system ofthe present invention.

FIG. 12 is a schematic illustration of the export process in the systemof the present invention.

FIG. 13 is a schematic illustration of the environment managementfunctions in the system of the present invention.

FIG. 14 is a schematic illustration of the concept of terminologymapping in the system of the present invention.

FIG. 15 is the schematic representation of the external vocabularyimport and mapping process in the system of the present invention.

DETAILED DESCRIPTION OF THE INVENTION

The present invention offers a unique approach to the selection andlocalization of clinical structured content (e.g., evidence-basedstructured content) in order to facilitate the rapid development andregular update of these structures. An implementation will be describedwith reference to FIGS. 1-15.

Referring to FIG. 1, embodiments of the present invention may facilitatethe rapid development of clinical content structures, such asevidence-based order sets, for use in the practice of delivering patientcare. Generally speaking, an information provider, which may be anorganization, team, third-party supplier, and so on, monitors the stateof the evidence for selected clinical situations and produces evidenceoverviews that suggest certain practices. This typically includes reviewof medical journal articles and publications, but also may includereviewing unpublished studies, internal reviews and data aggregation,and the like. In some embodiments, there may be one, two, or moreinformation providers.

This evidence-based content is used by the information provider toconstruct a superset of order sets that are suggested by the evidence.These order sets are useful in their own right, and to provide furtheradvantages in the use of such evidence and order sets (and/or in use ofother types of data), embodiments of the present invention provide anenvironment for the end user (typically one or more medicalpractitioners) to review the suggested orders in a collaborative settingand make changes to reflect the local availability of order items andcommon practice, and to then quickly integrate the localized contentinto healthcare application from various vendors.

As shown in the figure, in one embodiment, medical evidence 101 is usedin an evidence synthesis process 102 to generate aggregated evidence 103as well as default order sets 104. The synthesis 102 may includecomparing or reviewing evidence that was considered in the past, as wellas new evidence, to form a synthesis of available evidence. The defaultorder sets are order sets that are generated as a result of thesynthesis 102 of the evidence 101. The default order sets 104 may be ina standard term vocabulary 105 as described further herein.

The default order sets 104 are provided in an authoring environment,shown in the diagram as the AuthorSpace authoring environment 120. Theauthoring environment 120 allows a practice team 106, such as a hospitalpractice team to review and customize the default order sets 104. Thismay involve extensive review by a number of people, by all relevantpractitioners within a facility, or by a selected group or committee ofpractitioners. The result of the customization process 106 is alocalized order set, stored and maintained within the authoringenvironment 120. The localized order set 107 may be unchanged from thedefault order set 104 or may be modified as a result of review andmodification during the customization process 106. Following completionof the review, the localized order set may be transformed 109 into aformat suitable for a “target” health information technology (HIT)system that is used by the practitioners in question. For example, thetarget HIT system may be the HIT system for a hospital, medicalfacility, or doctor's office

The transformation 109 makes use of the standard term vocabulary 105used in creating and storing the default order sets 104 as well asinformation about the target HIT system 108. This information mayinclude a target HIT term catalog, which is information about the termsused or expected by the target HIT system. The localized order set 107is transformed 109 into the transformed, localized order set 110,preferably into a format that will allow the transformed, localizedorder set 110 to be imported easily into the target HIT system.

It should be understood that the techniques described with respect toFIG. 1 are applicable to any sort of clinical content, including withoutlimitation order sets, plans of care, rules (e.g., rules for alerting),alerts, protocols, performance measures, and/or structureddocumentation. Here, order sets may represent a collection of orders andnotations that are relevant to treating a given condition under a givenset of circumstances based upon current evidence. Plans of care refersto plans developed with health professionals that identify treatmentneeds, goals, and objectives of a participant based on clinicalassessments, and may provide strategies for meeting goals and objectivesand evaluating participant's progress. Rules and alerts refers toguidelines that show how evidence may be translated into alerts and/orreminders within electronic medical record systems. Performance measuresrefers to a process or outcome that addresses healthcare quality andsafety. Structured documentation refers to documentation of a patient'sphysical structure as may be included in medical records. The authoredcontent may include combinations of these, and may also include otherinformation, such as institutional data, policies, medical records, andmeta data, which may include links to relevant documentation (e.g.,evidence or practice patterns).

Referring to FIG. 2, a method for use of an authoring environment, forexample by a user is shown. In one embodiment, a medical practitioner,group of practitioners, and/or institution may begin by determining themedical condition or situation that requires clinical content, such asan evidence-based order set 201. This could be, for example, based ontheir current outcome information or based on information from aprovider, for example the EVIDENCE-BASED FORCASTER, available from ZynxHealth Incorporated of Los Angeles, Calif. After identifying therelevant health condition(s), the user may perform content navigation inthe authoring environment to peruse and select the default content 202available in their order set database 203. The default order sets may beorder sets from an information provider 203 or they may be from anothersuitable source, such as a related facility, or otherwise. Theyduplicate the default order set 204, for example, copying it into one ofthe folders in their authoring environment. One or more users then mayreview the recommended orders against their local order catalog 205 andagainst local common practice patterns either individually or in acollaborative work session. (it should be understood that many otherusage scenarios are possible). The user(s) can then edit the order set207, for example to localize it, perform an internal review 208, and ifdesired, allow for a public or more general review 209. The localizedorder set then may be approved and released 210. The order set isexported 211 into the specific vendor format and vocabulary for the HITapplication environment. The order set is then integrated 212 into thelive HIT application environment.

Again, it should be understood, that while the example of FIG. 2 isdescribed with respect to order sets, embodiments of the invention maybe applicable to any content that is agreed upon by a group and adoptedand integrated into an information technology system. The system hasparticular applicability for use with clinical content, because suchcontent typically is commented and agreed on by groups of practitionerswithin an office, institution (e.g., hospital, clinic, urgent carecenter, nursing home, group practice, emergency department, etc.),health care network, and so on prior to adoption, and also may be usefulin other types of environments that have similar needs, even outside ofhealth care.

Referring to FIG. 3, in some implementations, the system can alsoinclude features to ensure that content remains up to date as timepasses and new relevant information becomes available. How the changesin the evidence and practice affect the life cycle of an order set inone embodiment is depicted in the figure. Initially, an informationprovider creates a new order set based on the evidence for a givensituation 301. The user then chooses to duplicate and localize same andreleases it for use in their institution 302. The medical evidence canchange over time 303 and when that occurs, the information provider mayupdate the order set and publish it into authoring environment 304, forexample as a new version of the order set. Publishing the new version ofthe order set will trigger a notification to those users that duplicatedthe previous version 305 so that they can review the differences 306,update their local version as needed 307, release 308, export 309 andintegrate the new version into their healthcare application 310. Thisprocess may be iterative 311 as the evidence changes over time.

Referring to FIG. 4, depending on the HIT healthcare application, thetarget vocabulary of the final version of the file could be a standardvocabulary 403 (which may be a national standard code, such as SNOMED,LOINC, NDC's, CPT4, ICD9-CM, and so on), a vendor vocabulary that spansvendor customers 404, or a local catalog just for (or specific to) thelocation (e.g., hospital, clinic, urgent care center, nursing home,group practice, emergency department, healthcare network, or otherfacility) in question 405. A vocabulary mapping functionality 402 allowsfor the mapping of any of these to a standard term vocabulary 401, whichis used for storing and maintaining the order sets while they are in theauthoring environment, and before they are transformed into the localformat 403, 404, 405.

Referring now to FIG. 5, separate working environments for each facility(e.g., hospital, clinic, urgent care center, nursing home, grouppractice, emergency department, etc.) may be supported. Thus, anexemplary hospital, shown as HOSPITAL X, 504 can have a dedicatedenvironment 507. Within such an environment (e.g., 507) users haveaccess to the content they have localized and can define their ownmilestones and environmental preferences. The content and preferencesdefined in one environment, e.g., 507, may not be accessible to users inother environments (e.g., 505-506) as the authoring space may segregatecontent virtually 508 through its data structures. However, in somecases (e.g., when several hospitals are related through a common healthnetwork 501, 502, 503), access to environments of other users orinstitutions may be desirable. This can be provided through a mechanismin an authoring environment for the creation of related environments.Where related environments 505, 506 have been established, theenvironments of related hospitals 502,503 can be viewed by each other.If so configured, the related environments may allowed editing andcommenting by users associated with a related environment, without therisk of content corruption.

Referring to FIG. 6, in a typical implementation, access to anenvironment is protected by unique logins and passwords, with associatedaccess privileges. A user accessing an authoring environment typicallymay access content only in the manner that has been defined in theiraccess profile. The figure shows four exemplary users, USER A 603, USERB 604, USER C 605, and USER D 606. All users 603,604,605,606 within anauthoring environment 601 are members of what is called the base team602. Base team membership allows the users “view-only” access to thefull set of content in the environment. Within an environment the enduser can establish teams (e.g., SPECIALTY TEAM X 607, SPECIALTY TEAM Y608) for the creation of content and within those teams the users may begranted rights based upon their role on that team. Some users 605 maynot be assigned to a content team but may just be allowed view rights inthe authoring environment.

Referring to FIG. 7, once a user has accessed an embodiment of anauthoring environment, the initial page encountered by the user may bethe main page as depicted in the figure. On this page, a user can viewgeneral announcements or messages 701, see individualized notificationsregarding their environment or content 702, see a list of the teams theyare currently on 704, access additional functionality they may haveaccess to 703 or peruse content for editing or management 705,706. Sincesome users can access multiple environments the environment may bedisplayed on this page as well 707.

Authoring and Managing Content. Beyond environment administration thereare two major functions with regard to content development in anembodiment of an authoring environment: the content library, editor,manager, review tool and global content editor.

The content library is where the user can search for content to edit,customize or manage. This library may be located in the main screen asdepicted in FIG. 7. This library is organized into primary folders basedon the source of the content and then into sub-folders that have beencategorized by the aforementioned content source. In every case thereare at least two source folders, one for default content, for example asprovided by a service provider, and one for the environment's localcontent. If the user has rights to see other content sources (e.g., fromcommunities, vendors, etc. . . . ) they would see source folders forthem as well. The user can navigate the folders or can execute a searchacross the folders for specific content meta data. (e.g., reason, venue,author, status . . . ). Once selected, a user can edit, manage, delete,duplicate, print or export a content item.

Referring to FIG. 8, general navigation from the main page is depictedin this exemplary embodiment. From the main page 801, the user canperform content functions 805 or other activity functions 802. Activityfunctions may include environment management 803 which allows certainusers to modify the preferences, milestones and storage organization ofthe environment and vocabulary management 804, which allows the user toimport local order catalogs and map them to standard terms. Contentfunctions include viewing content, editing content 806 and managingcontent 807.

Referring to FIG. 9, the content editor is an application that allowsthe user to modify structured content. An exemplary embodiment of anorder set content editor is depicted in the figure. This interface isdesigned to accommodate organizing healthcare activities, orders andreminders into a logical structure dictated by the content author. Thus,the localization of the order set occurs in the order set editor.

The editor displays the order set in a hierarchical structure withsections 902 and order items 903. At the top of the editor is acollection of base functions that can be performed on the order set.These items are dynamic and can change depending on the order set in theeditor. They include adding sections to the root level of the order set,removing flagged items, inserting external order sets, un-deletingremoved items, and closing or checking the order set back in. Whileediting the order set, the user can select an item 902, 903 in the orderset structure and open a workspace 904 to edit the item. The userinterface within the workspace is dynamic and changes depending on thenature of the item being edited. An example might be for a simple orderitem like a lab test where, e.g., the workspace would open to allow theuser to enter schedule information (urgency, number of times per day,etc. . . . ) but for a medication order the details would includeelements like dose, dose form, special instructions and others. The usercan attach a reference to an item in the order set. The reference caneither be evidence from an information provider or any other validinternet address. The order set editor also allows the user to attachinternal notes and tasks to items in the order set.

In one embodiment, when a user edits an order set it is checked out tothat user and cannot be edited by another user until it has been checkedback in. This is to ensure that two users do not edit the order set atthe same time which would result in content corruption.

When the user is in the order set editor each change is sent back to theserver and stored in a binary cache file so that if the internetconnection is lost the last changes are preserved and available when theuser returns and edits the order set.

Using the content editor, a user can expand and contract the logicalstructure of the content and see the items with the links to evidencewhere applicable. For example, the user may open an item to modify it ormay choose to add a new item. Structured content can be represented in anumber of ways. For example:

-   -   A single orderable item like a lab test or medication may be        represented by a PIVOT term,    -   A reminder or free text narrative can be inserted in the content        to explain something to the user executing the structured        content in their workflow, and    -   A protocol which is a pointer to another, separate content        structure, can be used to nest structures together where        necessary.

In one embodiment, when a user chooses to add or edit an item, theeditor opens up a unique interface feature, referred to as a workspace.The workspace graphically expands the area containing the item; thisexpansion occurs in the display to accommodate the details required topopulate all of the data that is unique and required for the type ofitem that is being modified. This action is referred to as opening aworkspace. When the user is done making changes, the workspace is closedand the display reverts to the standard view of the item within thestructure (with appropriate modifications to reflect changes made to thedata).

Any item in the structure can be linked to evidence provided by aninformation provider or an external source (e.g., an internet URL) forreference at a later time. For example, if a user needs to link toevidence she can open the evidence browser which allows her to searchfor the evidence she feels supports the item in question. The user canalso attach notes or tasks to an item in the structure. These notes andtasks are for the users of the authoring environment within theauthoring environment and are not exported to the target system.

When content is accessed with the content editor, the content is checkedout to ensure that multiple authors are not trying to modify the samepiece of content simultaneously. If one user attempts to edit a piece ofcontent that has been checked out by another, a message is displayedexplaining that the content is already checked out and shows the username of the user who has it locked. During an edit session, the contenteditor streams every change made back to the server and those changesare saved to a ‘check-out’ file. Should the user lose their internetconnection, their changes are preserved and will be available the nexttime they edit that content item. The content remains in a checked outstate and can only be edited by the user who was working on it at thetime the connection was lost (though administrative overrides ortime-outs may be implemented to prevent “permanent” lock-out of anitem). When a user is done making changes they can save their changesand check in the content.

Referring to FIG. 10, a content manager allows the user to change howthe content fits into its environment. For example, changes can be madeto:

-   -   The meta-data (Reason, Venue, Event, etc) that the content item        is linked to,    -   The team that has rights to modify the content,    -   When the content expires,    -   The milestones that have been achieved relative to the content,    -   The system status of the content in the authoring environment        (Draft, Review, Released, Retired), and    -   Whether or not the content item is shown in the public View        Space for the environment.

When a content item is created, either from scratch or via theduplication of an existing work, it is stamped with a unique ID and aversion number. This version number is fixed when the content isreleased in the content manager. If a user chooses to edit a releasedcontent item a new draft with the same unique ID is created. When thenew draft is released the content manager automatically retires theprevious version and stamps the newly released content with the nextversion number. Preferably, retired versions of content are saved andcan be viewed as they existed at the time they were retired. If the usersets an expiration date for the content item in the content manager, theAuthoring environment notification system will alert the owner of thecontent when the expiration date arrives.

The content item can be linked to meta-data tags that help the consuminghealthcare application determine when to show the content to their user.The meta-data tags relate the content to certain conditions, proceduresor symptoms, a venue or location, a patient event and a specificinstitution if applicable.

The Content Review Tool. The content review tool allows the user toreview a content item and make remarks for the author. These reviews arekept with the draft version of the order set.

The Global Content Editor. The global content editor is a tool thatallows a user to execute bulk search and replaces across all of thereleased content in their environment. This can be used where, e.g., aparticular item (e.g., a particular drug or treatment) is determined tobe hazardous and needs to be removed from all content items as soon aspossible. Using the global content editor the user can quickly remove orreplace those items and quick release the resulting new versions ofthose content items.

The Notification Manager. The notification manager is designed to notifythe user when something happens that has relevance to them or a contentitem that they are responsible for. Events that potentially trigger thenotification manager include new releases of content items, expirationof content items, and relevant changes to source content or evidence. Inone embodiment, the notification manager posts a notice in the user'sauthoring environment home page and optionally email the notice to theemail address listed in the user's profile.

Exporting Content. An embodiment of the authoring environment includes adatabase to provide awareness of the healthcare applications used by aninstitution and has the facility to map PIVOT codes to the relevantlocal or standard vocabularies required by those applications. When auser chooses to export a content item, the user is presented with achoice of predefined exports. In one embodiment, the authoringenvironment has a standard XML export format as well as the customformats built for each system vendor.

Related Environments. An embodiment of an authoring environment has theability to relate environments to one another for the purposes ofsharing content. In some cases it could be that the health network has aparent environment and each hospital in the network has a childenvironment. Each child would be able to see content that was authoredat the network level and visa versa. This also facilitates the notion ofa content sharing community.

Still referring to FIG. 10, once the user has modified the order set inthe order set editor, the user can then manage the definitivecharacteristics, the condition, the venue and event the order set ismapped to as well as change the status of the order set using the orderset manager.

For example, on the order set manager page the user has functions theycan perform relative to the order set 1001. These functions can verydepending on the status of the order set. The characteristics of theorder set 1002 are the things that define the order set. The user canadd and update environment specific lifecycle events to the order set1003. The user can post a review of the order set from this page, orfrom the viewspace portal. In either case the reviews can be viewed fromthe page as well 1004. All changes made to the order set are logged inthe audit trail database. Major changes may be displayed in the orderset history list box on this page 1005. From this page the user can alsomark the order set as a protocol, which allows it to be virtually linkedinto other order sets, or publish the order set into the environment'sviewspace, which allows users who do not have access to the authoringenvironment to see the content on, for example, a reference website.

Referring to FIG. 11, in one embodiment, changing the status of an orderset, for example using the order set manager of FIG. 10, hasramifications with respect to the life cycle of an order set. Thesestatuses are schematically depicted in the figure. When an order set isinitially duplicated from the default order set, or created as blank,the order set is assigned an ID and has a status of draft 1102. While indraft status, the order set can be edited. Upon initial completion, thestatus of the order set can be changed to review 1103, which disablesediting and allows users to post reviews of the order set. The user canthen change the status back to draft 1102 to make additional edits inresponse to the reviews, or update the status to released 1104. When theorder set is released, it is stamped with a version number andpermanently locked. If the user should decide to edit the order set anew draft is created. When the new draft is ultimately released 1106 itis stamped with the next version number and the previously releasedversion is automatically retired 1105. Preferably, retired versions oforder sets are permanently stored for reference purposes. A user canabort a new draft without impacting a previously released version of theorder set.

Referring to FIG. 12, once a user is done editing the order set and hasreleased it, they export the order set. An exemplary embodiment of anexport process is depicted in FIG. 12. In order to resolve the issue ofportability of content, embodiments of the present invention have theability to transform both the terms used in the definition of the orderset and the structural format of the order set in order to make itconsumable within any healthcare application. When the order set isexported from the authoring environment 1201, the terminology istransformed 1202 by the vocabulary mapping functionality, as depictedwith reference to FIG. 4, and the resulting order set is created in astandard structure 1203. This structure may then be converted by acustom export engine 1204. The result is an export structure 1205 thatis in the format required by the vendor system using the terms from theusers local catalog.

It is noteworthy that depending on the healthcare application, thetarget vocabulary of the final version of the file could be a standardvocabulary 403, a vendor vocabulary that spans vendor customers 404, ora local catalog just for the hospital in question 405. The vocabularymapping functionality 402 allows for the mapping of any of these to thestandard term vocabulary 401.

Referring to FIG. 13, one or many users in a given environment may beassigned the privileges of the environment manager. This privilegeallows the user to access the environment manager link on the main pagein the activities section 703 (FIG. 7). The environment managementfunctions are depicted in FIG. 13. Once on the environment managementpage 1301, the user can perform several functions relating to themanagement of their environment. These include user management 1302,team management 1304, environment preferences 1307 and integrationoptions 1312.

User management 1302 allows the environment manager to add or modifyusers that have access to the environment 1303. By adding the user tothe environment, for example, they may give them view access on the baseteam in the authoring environment.

Team Management 1304 allows the environment manager to create 1305 andmanage 1306 teams. Managing the team is where users with access to theenvironment are added to teams and given team specific privileges thatrelate to the content that is owned by the team in question.

Environment Preferences 1307 is where many of the configurable optionsfor the environment can be manipulated by the environment manager.Storage management 1308 allows the environment manager to create andorganize their folder structure for storing their localized content.Milestone management 1309 allows the environment manager to createcontent life cycle milestones that will be used in the order set managerto measure local progress on order set development. Catalog management1310 allows the environment manager to add terms to authoringenvironment that are not in the standard catalog. These new terms can beaccessed by any environment user while in the order set editor.Notification management 1311 allows the environment manager to attachmilestone notifications to users in the environment.

Integration 1312 is where the environment manager can create allowableexports that can be selected by the environments users when they chooseto export an order set. Each environment is associated with one or manyhealthcare application vendors by administrative client servicespersonnel depending on what systems they have in their health network orhospital. These exports can be configured by associating exportvocabularies with a given export so that the proper terms are populatingthe right format.

Vocabulary management functionality in the present invention is used tosupport the transformation of the localized content into a form that isconsumable by the end user's healthcare application. Term mapping is therelating of identical terms in two distinct vocabularies FIG. 14illustrates an example of the concept of term mapping. In this case thestandard term vocabulary 1401 has a term representing a ‘Complete BloodCount’ lab test 1403. The external vocabulary 1402 has a term ‘CBC’ 1404that has the exact same meaning as the previously mentioned term in thestandard term vocabulary. These two terms could then be mapped so thatevery time the user selects the ‘Complete Blood Count’ term in theauthoring environment that item can be expressed to the consumingapplication with the ‘CBC’ identifier so that it can be understood.

Referring to FIG. 15, an embodiment of a process used to import and mapexternal vocabularies is depicted. The user may export a file from theirhealthcare application containing the terms from their orders catalog1501. The authoring environment's vocabulary import function 1502processes the file based upon parameters provided by the user and storesthe external terms in a database 1503 relative to the user'senvironment. At this point, the user may add or modify terms using thevocabulary maintenance functions 1504. The bulk of the effort would bein the mapping of the external terms to the standard term vocabulary1505. Using the authoring environment vocabulary mapping tool 1506, theuser would establish links 1507 between the stored external terms 1503and the standard vocabulary terms 1505. These links will later be usedby the export vocabulary transformation engine 1508 to transform thestandard terms in the order set structures into the term that can beunderstood by the user's healthcare application.

The invention may be implemented in digital electronic circuitry, or incomputer hardware, firmware, software, or in combinations of them.Apparatus of the invention may be implemented in a computer programproduct tangibly embodied in a machine-readable storage device forexecution by a programmable processor; and method steps of the inventionmay be performed by a programmable processor executing a program ofinstructions to perform functions of the invention by operating on inputdata and generating output. The invention may advantageously beimplemented in one or more computer programs that are executable on aprogrammable system including at least one programmable processorcoupled to receive data and instructions from, and to transmit data andinstructions to, a data storage system, at least one input device, andat least one output device. Each computer program may be implemented ina high-level procedural or object-oriented programming language, or inassembly or machine language if desired; and in any case, the languagemay be a compiled or interpreted language. Suitable processors include,by way of example, both general and special purpose microprocessors.Generally, a processor will receive instructions and data from aread-only memory and/or a random access memory. Storage devices suitablefor tangibly embodying computer program instructions and data includeall forms of non-volatile memory, including by way of examplesemiconductor memory devices, such as EPROM, EEPROM, and flash memorydevices; magnetic disks such as internal hard disks and removable disks;magneto-optical disks; and CD-ROM disks. Any of the foregoing may besupplemented by, or incorporated in, specially-designed ASICs(application-specific integrated circuits).

A number of embodiments of the present invention have been described.Nevertheless, it will be understood that various modifications may bemade without departing from the spirit and scope of the invention.

1. A system for collaborative review of a clinical content structure,the system comprising: a first authoring environment for reviewing theclinical content structure; and a second authoring environment forreviewing the clinical content structure, wherein a user in the firstauthoring environment is granted access to the first authoringenvironment, and a user in the second authoring environment is grantedaccess to the second authoring environment.
 2. The system of claim 1wherein at least a portion of the clinical content structure isevidenced-based.
 3. The system of claim 1 wherein the clinical contentstructure comprises an order set.
 4. The system of claim 1 wherein thesystem is a web-based system.
 5. The system of claim 1 wherein theauthoring environments are associated with different medicalinstitutions.
 6. The system of claim 1 wherein, if the first authoringenvironment and the second authoring environment are related through acommon network, a user in the first authoring environment may be grantedlimited access to the second authoring environment.
 7. The system ofclaim 6 wherein a user in the second authoring environment may begranted limited access to the first authoring environment.
 8. The systemof claim 6 wherein the common network is a common health network.
 9. Thesystem of claim 1 wherein a user's access to an authoring environment iscontrolled by a password.
 10. The system of claim 1 wherein a user'saccess to an authoring environment is view-only.
 11. The system of claim1 wherein access to an authoring environment is granted to a user basedon their role on a team.
 12. The system of claim 1 wherein a user'saccess includes content rights.
 13. The system of claim 1 wherein thefirst authoring environment is for reviewing and editing the clinicalcontent structure.
 14. The system of claim 13 wherein the secondauthoring environment is for reviewing and editing the clinical contentstructure.
 15. A method for collaborative review of a clinical contentstructure, the method comprising: providing a first authoringenvironment for reviewing the clinical content structure; providing asecond authoring environment for reviewing the clinical contentstructure; and granting access to a user in the first authoringenvironment to the first authoring environment, and granting access to auser in the second authoring environment to the second authoringenvironment.
 16. The method of claim 15 wherein at least a portion ofthe clinical content structure is evidenced-based.
 17. The method ofclaim 15 wherein the clinical content structure comprises an order set.18. The method of claim 15 wherein the system is a web-based system. 19.The method of claim 15 wherein the authoring environments are associatedwith different medical institutions.
 20. The method of claim 15 wherein,if the first authoring environment and the second authoring environmentare related through a common network, a user in the first authoringenvironment may be granted limited access to the second authoringenvironment.
 21. The method of claim 20 wherein a user in the secondauthoring environment may be granted limited access to the firstauthoring environment.
 22. The method of claim 20 wherein the commonnetwork is a common health network.
 23. The method of claim 15 wherein auser's access to an authoring environment is controlled by a password.24. The method of claim 15 wherein a user's access to an authoringenvironment is view-only.
 25. The method of claim 15 wherein access toan authoring environment is granted to a user based on their role on ateam.
 26. The method of claim 15 wherein a user's access includescontent rights.
 27. The system of claim 15 wherein the first authoringenvironment is for reviewing and editing the clinical content structure.28. The system of claim 15 wherein the second authoring environment isfor reviewing and editing the clinical content structure. 29-46.(canceled)